By Laetitia Rispel, University of the Witwatersrand
South Africa’s health ombudsman recently published the findings of an investigation into Rahima Moosa Mother and Child Hospital. The investigation followed the publication of a video showing pregnant women lying on the hospital floor, as well as complaints by patients’ family members. The ombudsman’s investigation produced shocking findings, including severe overcrowding and staff shortages at the facility. There haven’t been any substantial upgrades to the hospital since it was built 80 years ago.
Laetitia Rispel has been researching health policy and systems for over 20 years. She asked Professor Emeritus Yosuf “Joe” Veriava – who has been involved in South Africa’s healthcare system for more than half a century and is a recipient of the Order of Luthuli in silver for his contribution to the medical profession in South Africa – about the report.
Laetitia Rispel: What did you find most disturbing about the report? Who should be held accountable?
Yosuf Veriava: I spent most of my student or training years there in the late 1960s. Seeing the problems that are occurring now is very sad.
What I found particularly disturbing is the failure in providing appropriate, effective and efficient leadership.
At first glance I thought the only person to blame was the CEO. But the Gauteng provincial department of health is just as responsible. The department was involved in the appointment of the CEO. It was also the department that gave the CEO permission to work from home. I find this very problematic because the CEO of a hospital cannot work from home. The CEO could be needed at any time during working hours.
The CEO herself should be held responsible. And the Gauteng department of health must take some responsibility.
Laetitia Rispel: In your opinion, what factors have contributed to the hospital’s current state?
Yosuf Veriava: There are many.
First of all, it is the heavy patient burden. The hospital has a large catchment area. And within it, many of the people are of a lower social economic group and clearly their disease profile is not of the best.
This is the only mother and child hospital in South Africa, providing care for a very large number of women and children. In theory the hospital should be treasured, but the large patient numbers and high burden of care have a negative impact on the hospital.
Rahima Moosa Hospital delivers around 15,000 babies every year, which is the second highest number of babies in the country after Chris Hani Baragwanath Hospital (which is known as Africa’s biggest hospital). But the total staff complement is 1,200, and health professionals (doctors, nurses, pharmacists and rehabilitation therapists) account for 65% (780). Hence, the staff-to-patient ratio is low, even when compared to hospitals of a similar size.
Another aspect is the age of the hospital. The hospital is as old as I am – 80.
When I was at Coronation (the hospital’s old name) it was in reasonable shape. Not as good as the hospitals catering for white patients. But it was well kept.
When you have such an old hospital, there is a natural process of decay and this was not catered for. This points to the public works department failing to keep up with the decaying processes, and the maintenance of the hospital.
Laetitia Rispel: What should be done to turn the situation around?
Yosuf Veriava: It is the government that should be doing something about sorting this out. There are in fact recommendations that come out of the ombud’s report. These need immediate attention.
There have been concerns about public sector hospitals in general. And there have been various types of interventions.
In 2013, when I was professor emeritus of medicine at the University of the Witwatersrand, I was involved in a legal intervention to make a difference. We wanted to take the then health minister, Dr Aaron Motsoaledi, to court to compel him to take action.
While we were trying to bring the challenge to court, the minister said we should have discussions. These were held with the university as well as the minister’s office. The discussions resulted in an agreement on a turnaround strategy.
While this was positive and helped sort out the university-linked hospitals, it did nothing for the other state hospitals.
The other hospitals have received quite a bit of publicity.
There have been other attempts at interventions. One includes the drawing up of the Presidential Health Compact. While there was a lot of hype about the meeting with the president and the health compact, nothing much has happened and the hospitals remain the way they were.
So things get raised, but we don’t have any action.
Laetitia Rispel: What should be done to ensure a capable and functional public healthcare system in South Africa?
Yosuf Veriava: We can sort out all the hospitals. But the outcomes aren’t just going to improve suddenly.
Without sorting out the marked inequity in our country we will not make any major gains in improving health outcomes. There are many experts who believe that without sorting out various social and economic determinants we won’t have a very healthy society. So that’s the first point to make.
We are sending students to Cuba to try to facilitate the establishment of a health system based on primary healthcare. But our infrastructure here is not conducive to that. Hence, we should improve the primary healthcare system to cater for illnesses that can be seen at that level, which would take some of the extreme load from public sector hospitals.
We can look at improving hospitals but we also need to look at how to improve health outcomes.
Laetitia Rispel, Professor of Public Health and DST/NRF Research Chair., University of the Witwatersrand